Evidence of validity of the Brazilian version of the Cancer Behavior Inventory - Brief Version

Evidencia de validez de la versión brasileña del Cancer Behavior Inventory - Brief Version

ABSTRACT

Objective:

To analyze the validity evidence of the Brazilian version of the Cancer Behavior Inventory - Brief Version.

Method:

Methodological study, conducted between November and December 2021, with 140 patients undergoing hospital cancer treatment in João Pessoa, Paraíba, Brazil. Psychometric analyses were performed in the adapted version, using exploratory factor analysis and correlation with correlated constructs.

Results:

A two-factor and 10-item model was evidenced. The cumulative variance explained about 61% the shared variance of the items. Satisfactory values were observed for the factors in the analyses of composite reliability (0.89 and 0.91, respectively), internal consistency (0.86 and 0.91, respectively) and ORION (0.89 and 0.85, respectively). The expected correlations of self-efficacy with quality of life (convergent) and with anxiety and depression (divergent) were evident.

Conclusion:

The Brazilian version of the instrument showed evidence of validity, being considered reliable to assess the self-efficacy of patients undergoing cancer treatment.

Descriptors:
Self Efficacy; Medical oncology; Validation study; Reproducibility of results; Nursing methodology research

RESUMEN

Objetivo:

Analizar las evidencias de validez de la versión brasileña del Cancer Behavior Inventory - Brief Version.

Método:

Estudio metodológico, realizado entre noviembre y diciembre de 2021, con 140 pacientes en tratamiento oncológico hospitalario en João Pessoa, Paraíba, Brasil. Se realizaron análisis psicométricos en la versión adaptada, mediante análisis factorial exploratorio y correlación con constructos correlacionados.

Resultados:

Se evidenció un modelo de 2 factores y 10 ítems. La varianza acumulada explicó alrededor del 61% de la varianza compartida de los ítems. Se observaron valores satisfactorios para los factores en el análisis de confiabilidad compuesta (0,89 y 0,91, respectivamente), consistencia interna (0,86 y 0,91, respectivamente) y ORION (0,89 y 0,85, respectivamente). Se evidenciaron las correlaciones esperadas de la autoeficacia con la calidad de vida (convergente) y con la ansiedad y la depresión (divergente).

Conclusión:

La versión brasileña del instrumento mostró evidencias de validez, siendo considerado confiable para evaluar la autoeficacia de pacientes en tratamiento oncológico.

Descriptores:
Autoeficacia; Oncología médica; Estudio de validación; Reproducibilidad de los resultados; Investigación metodológica en enfermería

RESUMO

Objetivo:

Analisar as evidências de validade da versão brasileira do Cancer Behavior Inventory - Brief Version.

Método:

Estudo metodológico, realizado entre os meses de novembro e dezembro de 2021, com 140 pacientes em tratamento oncológico hospitalar em João Pessoa, Paraíba, Brasil. Foram realizadas análises psicométricas na versão adaptada, mediante a análise fatorial exploratória e correlação com constructos correlacionados.

Resultados:

Evidenciou-se um modelo de 2 fatores e 10 itens. A variância acumulada explicou cerca de 61% da variância compartilhada dos itens. Foram observados valores satisfatórios para os fatores nas análises de confiabilidade composta (0,89 e 0,91, respectivamente), consistência interna (0,86 e 0,91, respectivamente) e ORION (0,89 e 0,85, respectivamente). Evidenciaram-se as correlações esperadas da autoeficácia com a qualidade de vida (convergente) e com a ansiedade e depressão (divergente).

Conclusão:

A versão brasileira do instrumento mostrou evidências de validade, sendo considerada como confiável para avaliar a autoeficácia dos pacientes em tratamento oncológico.

Descritores:
Autoeficácia; Oncologia; Estudo de validação; Reprodutibilidade dos testes; Pesquisa metodológica em enfermagem

INTRODUCTION

Cancer is a complex and multifactorial disease, which has a significant impact on the current health scenario, standing as one of the main causes of morbidity and mortality worldwide. The continuous increase in the incidence of the disease represents a global burden for society and healthcare systems, with high costs associated with screening, diagnosis, treatment and palliative care1^-3.

The number of cancer cases has been increasing over the decades. In 2020 alone, there were more than 19 million new cases of cancer worldwide, and it is predicted that one in five individuals will develop the disease during their lifetime(4). In Brazil, an estimated 704 thousand new cases are expected for the three-year period from 2023 to 2025, with a higher incidence of non-melanoma skin cancer (31.3%), breast (10.5%), prostate (10.2 %), colon and rectum (6.5%), lung (4.6%) and stomach (3.1%)5.

Coping with cancer requires coordinated efforts at different levels of health care, upon the implementation of oncology care management in a broad, comprehensive, continuous and individualized manner1^,6. In this context, each patient’s needs, preferences, socioeconomic and cultural contexts, as well as the particularities of cancer type and stage must be understood. When considering these factors, it becomes possible to develop a care plan based on updated scientific evidence, which promotes better results and increases the well-being of affected patients2^,3^,7^,8.

Among these evidence, the use of self-efficacy stands out as an important tool for cancer care, playing a crucial role in strengthening the patient’s personal beliefs, in self-management of health, in promoting adherence to treatment, in establishing realistic expectations, managing stress and coping with unpleasant symptoms9^-13.

Self-efficacy refers to the judgments that individuals make about their competence to organize and execute actions necessary to achieve a certain performance. The perception of self-efficacy can be a powerful trigger for individuals to seek and achieve their goals, directly influencing behavior, choices, the amount of effort that will be invested and the persistence in keeping even in the face of obstacles or temporary failures13^,14.

The assessment of self-efficacy is essential in the care of individuals with cancer, as it allows a deeper understanding of the specific needs and challenges faced by each patient. By assessing self-efficacy, nursing professionals can identify specific areas that require additional support and develop targeted interventions to strengthen confidence and the ability to deal with obstacles during treatment13^,15^,16.

Although the importance of self-efficacy in healthcare is widely recognized, the availability of specific instruments to assess this concept in clinical practice is still limited, especially in specific contexts, such as oncology7^,9^,10^,13^,17. At the Brazilian scenario, the absence of an adapted instrument to measure the self-efficacy of cancer patients represents a gap in the care for this population.

Among the specific instruments for measuring self-efficacy in cancer treatment, the Cancer Behavior Inventory - Brief Version (CBI-B) stands out for having been subjected to rigorous psychometric validation processes16. The CBI-B is an instrument developed in the United States, which allows obtaining a general estimate of self-efficacy in cancer treatment, supporting the implementation of interventions to reduce patient suffering16.

Due to its relevance in oncology, the CBI-B is used worldwide, with versions adapted for Saudi Arabia2, Turkey3, China7, Italy9 and Portugal10, which shows its adaptability and usefulness in different clinical contexts. In this sense, adapting the CBI-B to Brazilian culture will result in the availability of a culturally relevant, linguistically appropriate and psychometrically valid instrument to assess the self-efficacy of cancer patients in the Brazilian context. This can enable a deeper understanding of these patients’ needs and contribute to individualized, effective and safe nursing care.

The hypothesis of the present study is that the Brazilian version of the CBI-B presents evidence of satisfactory validity and reliability to adequately assess the self-efficacy of patients undergoing oncological treatment. Therefore, the objective was to analyze the validity evidence of the Brazilian version of the CBI-B.

METHOD

This is a methodological research conducted in two stages. Initially, the cross-cultural adaptation of the CBI-B was carried out, which followed five interrelated stages (Figure 1)18. Afterwards, psychometric analyses were carried out to seek evidence that proves the validity of its adapted version for Brazilian culture.

Figure 1 -
Stages of the cross-cultural adaptation process of the Cancer Behavior Inventory - Brief Version for Brazil. João Pessoa, Brazil, 2021

The study was conducted between November and December 2021, in a High Complexity Oncology Care Center in the capital of Paraíba, with the study population consisting of adults and elderly people who were undergoing treatment at the institution.

The sample was defined based on literature, which suggests that instrument validation requires at least 10 individuals per item19. In this case, we chose to use the version with 14 items, as occurred in other versions of the CBI-B2^,3^,7^,9^,10, given that the two items excluded in the original version16 could be maintained when evaluated in different cultures. Thus, the sample consisted of 140 participants.

The inclusion criteria were: being 18 years old or over; have a medical diagnosis of cancer; and undergoing oncological treatment for at least 30 days, allowing the patient to have undergone at least four chemotherapy sessions and/or 20 radiotherapy sessions16. The following exclusion criteria were defined: being in palliative/specialized care for end-of-life; having a severe communication deficit, such as aphasia, apraxia of speech, dysarthria, receptive-expressive language disorders, hearing impairment, among others; and presenting clinical complications at the time of data collection after two attempts.

Patients were selected for convenience, among individuals who were in the waiting room for oncological care. All those who met the inclusion criteria were invited to participate in the individual interview. These individuals were then guided about the research and were asked to sign the Informed Consent Form. There were no sample losses throughout the research.

The characterization of the sociodemographic profile and clinical condition of patients was made using the following variables: age, gender, marital status, education level, type of cancer, time since diagnosis and current treatment. To measure self-efficacy, the Brazilian version of the CBI-B, called CBI-B/BR, was used, which is consisted of 14 items distributed on a 9-point Likert scale. The score is calculated by the sum of the responses of each item, where the higher the value, the greater the self-efficacy16.

Convergent validity was measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30), which assesses the impact of cancer and its treatment on the patient’s quality of life20. To measure divergent validity, the Hospital Anxiety and Depression Scale (HADS) was used, an instrument that allows the detection of mild degrees of affective disorders in non-psychiatric environments21.

Descriptive analyses were performed to characterize the studied sample and psychometric analyses to measure the validity and reliability of the CBI-B/BR. The Bootstrap resampling technique was used to increase the chance of representativeness of the sample within the universe of patients undergoing oncological treatment. Thus, based on the original sample of 140 individuals, another 500 samples were simulated to estimate the characteristics presented in the real population, obtaining a 90% confidence interval.

The sampling adequacy index was assessed by the Kaiser-Meyer-Olkin (KMO) measure and the Bartlett Test of Sphericity, being used as introductory analyses to indicate the possibility of carrying out exploratory factor analysis22. After confirmation of indication, the calculation was made to evaluate the factorial structure of the instrument, being implemented based on a polychoric correlation matrix.

Exploratory factor analysis allows the internal assessment of the instrument, based on the definition of the data structure, which demonstrates the interrelationships between the items and the way in which their grouping explains the formation of one (one-dimensional) or more factors/dimensions (two-dimensional or multidimensional)23.

The selection of the common number of factors, their extraction, and the indication of the importance degree of each item for the factor were carried out. The common number of factors that should be removed from the instrument was determined by the Robust Promin rotation24. Additionally, the possibility of unidimensionality was assessed using the factor determination index25. Factor reliability was estimated using Cronbach’s Alpha Coefficient, Composite Reliability and Overall Reliability of previous fully informative oblique N-EAP scores (ORION), with results above 0.70 being recommended25.

The model fit adequacy was assessed by the indices of root mean square error of approximation, comparative fit index and non-normative fit index26. Convergent and divergent validity were measured by the correlation between the CBI-B/BR, the EORTC QLQ-C3020 and the HADS21, using Pearson’s bivariate correlation test.

The research project was approved by the Research Ethics Committee of the Health Sciences Center of the Universidade Federal da Paraíba, under opinion number 4,622,548. The study was developed in compliance with the ethical standards recommended by Resolution No. 466/2012. Formal authorization for the cross-cultural adaptation of the CBI-B was granted by the author of the original instrument, upon electronic message.

RESULTS

Among the 140 participants, a higher frequency of women (63.6%), elderly (60.1±15.5), married or in a stable union (63.6%), education level with a median of 5.5 years was observed. (Q1=2.0; Q2=5.50; Q3=12.0), diagnosis of breast cancer (32.9%), time since diagnosis with a median of 1 year and 1 month (Q1=10 months; Q2 =1 year and 1 month; Q3=1 year and 11 months) and who were undergoing radiotherapy treatment (51.4%), as shown in Table 1.

Table 1 -
Sociodemographic and clinical profile of patients undergoing oncological treatment. João Pessoa, Brazil, 2021

Variables	n	%
Gender
Female	89	63.6
Male	51	36.4
Age group (years)
≤ 19	2	1.4
20 - 29	2	1.4
30 - 39	11	7.9
40 - 49	23	16.4
50 - 59	24	17.1
60 - 69	31	22.1
70 - 79	41	29.3
80 or more	6	4.3
Marital status
Married or stable union	89	63.6
Single	26	18.6
Widowed	17	12.1
Divorced	8	5.7
Education level (years of study)
Illiterate	20	14.3
1 - 4	46	32.8
5 - 8	42	30.0
9 - 11	19	13.6
≥ 12	13	9.3
Type of cancer
Breast	46	32.9
Prostate	25	17.9
Cervix	16	11.4
Head and neck	16	11.4
Ovary	6	4.3
Skin	5	3.6
Lung	4	2.9
Others	22	15.6
Time since diagnosis (years)
< 1	44	31.4
1 - 2	70	50.0
3 - 4	20	14.3
5 or more	6	4.3
Current treatment
Radiotherapy	72	51.4
Chemotherapy	38	27.1
Chemotherapy + radiotherapy	25	17.9
Surgery	5	3.6
Total	140	100.0

• Source: Research data, 2021.

The sampling adequacy index showed acceptable results, with a good KMO (0.822; 90% CI: 0.618-0.830) and a statistically significant Bartlett test of sphericity (654.9; gl=45; p<0.001), which indicates the interpretability of the item correlation matrix. The two-factor model was the most representative for the data.

Among the 14 items in the adapted version of the CBI-B/BR, four were excluded. Items 3 - “Maintain good mood” and 7 - “Remain calm during all treatments and do not allow negative thoughts to upset me” presented factor loadings lower than recommended (< 0.50).

On the other hand, items 9 - “Ask healthcare professionals questions about the treatment” and 13 - “Being able to adapt to the physical changes caused by the treatment” exhibited a pattern of cross-loadings, with a value above 0.30 in both factors. The best adjustment was found in the factorial structure composed of two factors and 10 items, which required the reorganization of the instrument after the exclusion of the 4 items (Chart 1).

Chart 1 -
Validated version of the “Cancer Behavior Inventory - Brief Version (CBI-B/BR)”. João Pessoa, Brazil, 2021

Factor 1 - Maintenance of routine
1.	Maintain independence (being able to perform actions and make your own decisions, without help or influence from other people)
2.	Maintain a positive attitude
4.	Distract from negative thoughts
5.	Maintain routine activities (work, studies, home, leisure and social life)
9.	Manage nausea and vomiting
10.	Remain calm while waiting for my appointment
Factor 2 - Coping with the disease and emotional control
3.	Express negative feelings about cancer
6.	Participate in treatment decisions
7.	Seek social support (family, friends, community and professionals)
8.	Share my concerns with others

• Source: Research data, 2021.

The accumulated variance of the factors (46% and 15%, respectively) explained about 61% of the shared variance of the items. The instrument did not support unidimensionality, showing the presence of a second factor (FDI=0.94 and 0.92, respectively). Satisfactory values were observed for both factors in the analyses of composite reliability (0.89 and 0.91, respectively), internal consistency (0.86 and 0.91, respectively) and ORION (0.89 and 0.85, respectively), as observed in Table 2.

Table 2 -
Description of the factorial structure of the “Cancer Behavior Inventory - Brief Version”. João Pessoa, Brazil, 2021

Items	Factor 1	90% CI	Factor 2	90% CI
Item 1	0.487	0.303 - 0.644	0.221	-0.014 - 0.394
Item 2	0.832	0.691 - 0.958	0.123	-0.031 - 0.276
Item 4	0.659	0.521 - 0.783	0.220	0.058 - 0.380
Item 5	0.669	0.471 - 0.818	-0.001	-0.203 - 0.190
Item 9	0.740	0.556 - 0.890	-0.109	-0.284 - 0.089
Item 10	0.699	0.518 - 0.905	-0.232	-0.463 - -0.041
Item 3	0.222	0.080 - 0.360	0.558	0.318 - 0.680
Item 6	-0.001	-0.139 - 0.152	0.773	0.549 - 0.909
Item 7	0.028	-0.095 - 0.130	0.849	0.717 - 0.969
Item 8	0.262	0.117 - 0.388	0.531	0.375 - 0.683
Eigenvalue	4.66	-	1.54	-
Explained variance	0.46	-	0.15	-
Factor Determination Index - Factor Determination Index	0.94	-	0.92	-
Composite reliability	0.89	-	0.91	-
Internal consistency
Cronbach’s alpha	0.86	-	0.91	-
ORION	0.89	-	0.85	-

• Source: Research data, 2021.

The instrument’s adjustment indices presented appropriate values (X² = 32.626, gl = 26; p < 0.001; RMSEA = 0.043; NNFI = 0.988; CFI = 0.993) (Table 3).

Table 3
Distribution of adjustment indicators for validation of the “Cancer Behavior Inventory - Brief Version”. João Pessoa, Brazil, 2021

Items	Criteria	Bifactor model	90% CI
Root mean square error of approximation - RMSEA	0.010 - 0.050	0.043	0.000 - 0.055
Tucker-Lewis index - TLI	> 0.90	0.988	0.977 - 1.006
Comparative fit index - CFI	> 0.90	0.993	0.987 - 1.003

• Source: Research data, 2021.

The expected correlations of self-efficacy with the EORTC QLQ-C30 (convergent) and with the HADS (divergent) were evident. Significant and positive correlations were observed between self-efficacy and total health-related quality of life (HRQoL) and its scales. On the other hand, self-efficacy showed significant and negative correlations with the HADS domains (Table 4).

Table 4 -
Description of the convergent and divergent analysis of the “Cancer Behavior Inventory - Brief Version”. João Pessoa, Brazil, 2021

Variables	Self-efficacy
	Factor 1		Factor 2		Total
	r	p-value*	r	p-value*	r	p-value*
Global Health Scale	0.263	0.002	0.202	0.016	0.264	0.002
Functional Scale	0.413	<0.001	0.285	0.001	0.398	<0.001
Symptom Scale	-0.173	0.041	-0.026	0.765	-0.119	0.161
HADS
Anxiety	-0.402	<0.001	-0.316	<0.001	-0.407	<0.001
Depression	-0.682	<0.001	-0.518	<0.001	-0.698	<0.001

• Source: Research data, 2021.
• * Pearson’s correlation test; significant value: p≤0.05.

DISCUSSION

The structure of the Brazilian version of the CBI-B was composed of two factors and 10 items, while the original American version is composed of four factors and 12 items16. In all versions of the CBI-B2^,3^,7^,9^,10, the validation process also had a different structure from the original version16.

Modifications to the structure of the instrument in relation to the original version are frequent and expected during the validation process. Culture influences people’s behaviors, beliefs and attitudes, therefore, instruments need to be sensitive to these differences18^,19.

The exclusion of items does not necessarily mean a loss in the instrument, as it is based on scientific evidence and careful evaluation by expert judges in the area. In fact, the removal of problematic or inappropriate items can improve the quality of the adapted instrument, better reflecting the cultural reality of the country and the customs adopted by its population17^-19^,23.

The analysis of the factorial structure of the CBI-B/BR revealed that the instrument was composed of two distinct factors that measured self-efficacy. Therefore, it was necessary to change the wording of the factors to accurately reflect the associated actions or behaviors.

Factor 1 was defined as “Maintenance of routine” as it included items that dealt with the efforts made by the patient to preserve their daily activities, despite facing difficulties from the disease and its treatment. When an individual is diagnosed with cancer, they face a series of physical, emotional and social challenges. Therefore, maintaining a daily routine during this period can be an important way of coping, as it promotes a sense of normality and a feeling of control over own life13^,27.

Preserving a routine, even with difficulties, contributes to actively face problems related to the disease and treatment, in addition to support the desired objectives and results, which may include keeping external activities, such as work, studies, personal care, leisure and relationships, which are important for overall well-being and improve quality of life14^,15^,27.

Factor 2 of the CBI-B/BR was called “Coping with the disease and emotional control”. This definition was assigned based on the items that compose the factor, which address behaviors related to two fundamental aspects to promote self-efficacy in cancer patients: facing obstacles resulting from the disease and maintaining emotional control during the different stages of oncological treatment.

Coping with the disease refers to the efforts that patients make to deal with the complex challenges due to cancer and to take control of the situation, promoting a greater sense of self-efficacy. Furthermore, emotional control is an essential part of the process of coping with cancer, as patients deal with a variety of intense emotions on a daily basis, such as fear, anxiety, sadness and stress. Thus, these individuals need to develop and mobilize internal and external controls to face these emotions in a healthy and constructive way13^,14^,16^,28.

The reliability and internal consistency indicators of the CBI-B/BR showed that the instrument is capable of measuring self-efficacy in patients undergoing oncological treatment in a reliable and consistent manner, which strengthens the validity of the instrument and increases confidence in the results obtained from its use in the Brazilian population.

The reliability of an instrument is a fundamental aspect in scientific research, as it indicates the ability to provide accurate and consistent results, even when applied repeatedly under the same conditions or in different cultures. When an instrument presents strong reliability values, this suggests that the scientific process used in its construction and/or adaptation was rigorous and reliable24^-26.

The convergent and divergent validity analysis confirmed the expected results, in which self-efficacy showed a positive correlation with HRQoL, corroborating the data obtained in the Turkish2, Italian9 and Portuguese10 versions. The HRQOL encompasses several domains that can be significantly affected during cancer treatment. In this context, self-efficacy emerges as an important element to positively influence the HRQoL of these patients11^,13.

When an individual has a high level of self-efficacy, they tend to feel more confident and able to face the challenges associated with cancer treatment, which favors autonomy, active participation in decision-making on health care, management of symptom unpleasant, adherence to treatment and adoption of healthy behaviors14^,28.

A study conducted in an oncology rehabilitation clinic in Germany showed that self-efficacy was a predictor of HRQoL, in which patients who felt more competent and confident in dealing with the challenges associated with treatment had better quality of life results. This indicates that the perception of self-efficacy plays an important role in the way patients face and deal with the disease14.

Similarly, a research conducted with Italian patients undergoing esophagectomy observed that higher self-efficacy scores before surgery were strong predictors of better overall health and higher levels of quality of life in the three months following the procedure. This result suggests that personal belief in one’s own ability to deal with the challenges of treatment and recovery can have a positive impact on HRQoL and psychosocial adaptation28.

In light of this, it becomes crucial to develop actions based on scientific evidence that prove their effectiveness in increasing self-efficacy levels. Strengthening personal efficacy beliefs in cancer patients does not replace conventional medical treatment, but can complement it, through the implementation of a more integrated approach for overall well-being and improvement of quality of life14^,27.

In the analysis of divergent validity, negative correlations were identified between self-efficacy and anxiety and depression. These findings are consistent with previous research that highlights the inverse relationship between the concepts, as evidenced in the validations for the Italian9 and Portuguese10 languages.

In oncological patients, the presence of psychological problems such as anxiety and depression is frequent, since the diagnosis of the disease is often perceived as a synonym for death. Furthermore, cancer treatment can be a significant source of stress, uncertainty and drastic changes in an individual’s routine, which can trigger a series of emotional challenges and affect mental health and psychological well-being1^,14^,15^,28.

Self-efficacy stands out as an important mediator of anxiety and depression levels in oncology. Patients with greater self-efficacy are more likely to seek effective strategies to deal with problems triggered by cancer, which contributes to a greater perception of control over their own lives and reduces levels of anxiety and depression12^,13^,15.

The CBI-B/BR can be used as an assessment tool and to support nursing care in oncology, encompassing the physical and emotional needs of patients. As practical applications of the instrument, there are: identify adaptive and maladaptive behaviors; understand the patient’s coping mechanisms; highlight areas in which the patient may be experiencing emotional difficulties; monitor progress over time, note positive or negative changes in behavior; and plan specific care aimed at addressing the emotional and behavioral challenges that the patient is experiencing8^,13^,15^,16^,29^,30.

The construction of a more assertive and customized nursing care plan using the CBI-B/BR requires a detailed analysis of sociodemographic characteristics (such as age, gender, education level and income), the clinical-pathological profile (type of cancer, stage of disease, time of diagnosis, therapy, associated comorbidities, among others), the patient's coping resources (emotional aspects, self-esteem and resilience), the support/social support network (family, friends and community) and the cultural aspects of the patient (customs, spirituality and beliefs). Furthermore, it is important to include the patient in this process, which makes healthcare more focused on individuals and their needs8^,12^,13^,16^,29^,30.

The outcomes of this research have some limitations. The use of a 9-point Likert scale may have posed a barrier to the accurate assessment of self-efficacy, since there is difficulty in distinguishing the most appropriate response for each item, leading to a bias of underestimation or overestimation.

The generalization of findings to the entire national territory is limited by the following factors: data collection taking place in a public oncology service; the cultural differences that exist between the states and regions of the country; and the heterogeneity of the studied population regarding age, different types of cancer and time since diagnosis. Therefore, for future studies, it is suggested to focus on a single type of cancer to make the sample more homogeneous.

Despite these limitations, the composition of a considerable sample size and the use of a gold standard method for cross-cultural adaptation and validation of the CBI-B/BR are strengths of the study, which increase the reliability of the results obtained.

CONCLUSION

The assessment of the psychometric properties of the CBI-B/BR showed that the instrument adapted for Brazilian culture maintained the characteristics of the original version, demonstrating its robustness and ability to appropriately measure self-efficacy in cancer patients. The study hypothesis was confirmed, as the instrument presented satisfactory evidence of validity and reliability to adequately measure the self-efficacy of patients undergoing oncological treatment.

The CBI-B/BR can be used in different clinical, care, and educational contexts. In nursing care for cancer patients, its use can bring significant benefits to care management at all levels of care. Through its application in clinical practice, professionals can have a better understanding of the patient’s perceptions, expectations, and resources for coping with the disease and treatment, in addition to favoring the construction of an accessible care plan, in which all actions would be agreed with the individual and their family members.

In nursing education, the CBI-B/BR can be used in the classroom as teaching material during the oncology courses and/or in practical, university extension programs and scientific initiation activities to assess levels of self-efficacy and its variations after the application of specific interventions.

Within the scope of nursing research, the CBI-B/BR can be used as a data collection instrument for exploratory and cross-sectional studies, aiming at a better understanding of factors related to self-efficacy in various types of cancer. In longitudinal research, the application of this scale allows the assessment of self-efficacy over time, identifying cause and effect relationships with other variables relevant to the theme of oncology.

Acknowledgments:

To the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES) - Funding Code 001.

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Edited by

Associate editor:

Luccas Melo de Souza

Editor-in-chief:

João Lucas Campos de Oliveira

Publication Dates

• Publication in this collection
  12 Feb 2024
• Date of issue
  2024

History

• Received
  06 June 2023
• Accepted
  12 Sept 2023